NEW YORK (Reuters Health) - Black and Latina breast cancer
patients were more than twice as likely as white women to have
lingering medical debt and to skip treatments because of costs,
according to a new U.S. study.

Based on surveys of 1,500 women diagnosed with mostly
early-stage breast cancers, researchers found that up to one
quarter were struggling financially as a result of their
disease.

"Although we were able to control for factors such as
overall household income in this study, it is likely that other
disparities and challenges faced by minority populations persist
in our society even today, contributing to the differences
observed," author Dr. Reshma Jagsi told Reuters Health by email.

Jagsi worked on the study in the Department of Radiation
Oncology at the University of Michigan in Ann Arbor.

Between 2005 and 2007, she and her coauthors surveyed women
diagnosed with mostly early-stage breast cancers that had not
spread nine months after diagnosis and four years later. The
women lived in the Los Angeles and Detroit areas and about half
had received chemotherapy.

Of those women, 12 percent reported having medical debt at
the four-year survey.

That group included nine percent of the white women
participating in the survey, compared to 10 percent of the
Spanish-speaking Latinas, 17 percent of the English-speaking
Latinas and 15 percent of the black women, according to the
results in the Journal of Clinical Oncology.

These proportions persisted even when the researchers
accounted for income, education and employment.

About 35 percent of the women reported spending $2,000 or
more out-of-pocket on cancer treatments, and 17 percent spent
more than $5,000.

At the four-year mark, some survey questions assessed the
level of financial strain the women had been under for the past
year.

Six percent of black women, compared to 3 percent of white
women, said they had taken less than the full amount of their
prescribed medications in the last year due to cost. Black and
Latina women were also more likely to have missed doctor
appointments due to cost than white women.

Black and Latina women were more likely to have gone without
health insurance or moved out of their houses due to cost since
their cancer diagnosis, although only five percent of women
total had to do this.

Two percent of white women reported having utilities turned
off due to unpaid bills, compared to 11 percent of black women.

"Overall, cancer is one of the most expensive diseases to
treat in the United States," Dr. S. Yousuf Zafar told Reuters
Health by email.

Zafar, a medical oncologist at Duke Cancer Center in Durham,
North Carolina, was not involved in the new study.

"Compared to patients with chronic illnesses other
than cancer, patients with cancer are at risk for higher
treatment-related out-of-pocket expenses," he said.

Cancer patients face direct costs, like copayments for
prescription medications, visit copays, and coinsurance, and
indirect costs, like lost income from time off work,
transportation for treatment, and childcare, he said.

Minority populations might be especially at risk due to
insufficient employee health benefits, cultural barriers and
poor health literacy, he said, especially since Spanish-speaking
Latinas were at the greatest risk for declining financial
status.

"Our findings suggest that racial and ethnic minority
patients appear to be more vulnerable, as are those who are too
young to qualify for Medicare, those who lack prescription drug
coverage, those who reduce their work hours after diagnosis, and
those with lower household income at the time of diagnosis,"
Jagsi said.

Women who receive chemotherapy or who have recurring breast
cancers may also be at higher risk for financial decline, she
said.

Health care providers need to be sure to communicate with
newly diagnosed cancer patients about the financial implications
of cancer diagnosis and treatment decisions, she said.

"Specific provisions in the (Affordable Care Act), including
annual caps on out-of-pocket spending, will hopefully ease some
of the financial burden experienced by patients," Zafar said.
"However, in reality, we know very little about how those
provisions will actually translate into cost savings for
patients."